학술논문
Trends in Outcome of Hematopoietic Stem Cell Transplantation: 5000 Transplantations and 30 Years of Single-Center Experience.
Document Type
Article
Author
Zubarovskaya, Ludmila Stepanovna; Moiseev, Ivan Sergeevich; Vladovskaya, Maria Dmidrievna; Mikhailova, Natalia Borisovna; Morozova, Elena Vladislavovna; Bykova, Tatyana Alexandrovna; Vlasova, Yulia Yurievna; Paina, Olesya Vladimirovna; Kazantsev, Ilya Viktorovich; Slesarchuk, Olga Alexandrovna; Smirnova, Anna Gennadyevna; Osipova, Anna Alekseevna; Stelmakh, Liliya Vladimirovna; Polushin, Alexey Yurievich; Goloshchapov, Oleg Valerievich; Bogomolny, Maxim Pavlovich; Estrina, Maria Arkadievna; Popova, Marina Olegovna; Kucher, Maxim Anatolievich; Volkova, Alisa Georgievna
Source
Subject
*LYMPHOBLASTIC leukemia prognosis
*HODGKIN'S disease
*CHRONIC lymphocytic leukemia
*HOMOGRAFTS
*MULTIVARIATE analysis
*APLASTIC anemia
*CANCER relapse
*TREATMENT effectiveness
*AUTOGRAFTS
*QUALITY assurance
*RESEARCH funding
*HEMATOPOIETIC stem cell transplantation
*MULTIPLE myeloma
*TUMORS
*INBORN errors of metabolism
*PROPORTIONAL hazards models
*NON-Hodgkin's lymphoma
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Language
ISSN
2072-6694
Abstract
Simple Summary: Despite several registry studies on the longitudinal outcomes of hematopoietic cell transplantation (HCT), there is limited information on the major trends in HCT in developing countries. This single-center study evaluates the development of a large transplantation center over 30 years. The analysis includes 5185 transplantations and focuses on major trends in indications over time and changes in outcomes according to the underlying disease. The most significant improvements of survival after autoHCT were observed in Hodgkin's disease (HR 0.1, 95% CI 0.1–0.3), multiple myeloma (HR 0.4, 95% CI 0.2–0.7) and solid tumors (HR 0.2, 95% CI 0.2–0.4). The most significant improvements in survival after alloHCT were observed for acute myeloid leukemia (HR 0.3, 95% CI 0.1–0.5), acute lymphoblastic leukemia (HR 0.2, 95% CI 0.1–0.5), Hodgkin's disease (HR 0.1, 95% CI 0.0–0.4), non-Hodgkin's lymphomas (HR 0.2, 95% CI 0.0–0.6), inborn diseases (HR 0.2, 95% CI 0.2–0.4) and acquired aplastic anemia (HR 0.3, 95% CI 0.2–0.8). In this single-center analysis, we evaluated the trends in 5185 hematopoietic cell transplantations performed between 1990 and 2022. The study group comprised 3237 allogeneic (alloHCT) and 1948 autologous (autoHCT) hematopoietic cell transplantations. In the multivariate analysis, there was an improvement in event-free-survival (EFS) after autoHCT (HR 0.6, 95% CI 0.4–0.7, p < 0.0001) due to reduced cumulative incidence of relapse in the last five years (56% in 2010–2014 vs. 38% in 2015–2022). An improvement in EFS after alloHCT over time was observed (HR 0.33, 95% CI 0.23–0.48, p < 0.0001), which was due to reduced non-relapse mortality. No difference in cumulative relapse incidence was observed over the last decade for allografted patients. Survival after autoHCT improved in Hodgkin's disease (HR 0.1, 95% CI 0.1–0.3), multiple myeloma (HR 0.4, 95% CI 0.2–0.7) and solid tumors (HR 0.2, 95% CI 0.2–0.4), while after alloHCT, improvement was observed in acute myeloid leukemia (HR 0.3, 95% CI 0.1–0.5), acute lymphoblastic leukemia (HR 0.2, 95% CI 0.1–0.5), Hodgkin's disease (HR 0.1, 95% CI 0.0–0.4), non-Hodgkin's lymphomas and chronic lymphocytic leukemia (HR 0.2, 95% CI 0.0–0.6), inborn diseases (HR 0.2, 95% CI 0.2–0.4) and acquired aplastic anemia with matched related donors and matched unrelated donors (HR 0.3, 95% CI 0.2–0.8). [ABSTRACT FROM AUTHOR]